Upper Gastrointestinal Symptoms in Obese Patients and Their Outcomes After Bariatric Surgery

Marilia Carabotti; Carola Severi; Frida Leonetti; Francesco De Angelis; Olga Iorio; Enrico Corazziari; Gianfranco Silecchia

Disclosures

Expert Rev Gastroenterol Hepatol. 2013;7(2):115-126. 

In This Article

Abstract and Introduction

Abstract

Obesity is considered an important risk factor for the development of gastrointestinal (GI) disorders, likely through alterations of GI motility. Even though gastroesophageal reflux disease is the condition mainly studied at present, the prevalence of other upper GI symptoms is also augmented in obese patients. Owing to their chronic trend, these disorders have a bearing on public spending and their correct diagnosis would avoid unnecessary cost-consuming investigations. Furthermore, bariatric surgery dramatically changes GI anatomy and physiology, influencing GI symptom outcomes. The aim of this review is to categorize the available results in a pathophysiological framework in an attempt to set up the correct clinical GI management of obese patients before and after bariatric surgery. This would be helpful in tentatively reducing their considerable economic burden on public health services.

Introduction

In previous years, morbid obesity has become an epidemic condition and worldwide its incidence has more than doubled since 1980. In 2008, more than 1.4 billion adults aged 20 years and older were overweight. Of these, more than 200 million men and nearly 300 million women were obese.[201] This alarming situation leads to a significant rise in healthcare costs due to obesity-related, chronic medical conditions such as hypertension, diabetes, dyslipidemia, sleep apnea and cardiovascular diseases. Furthermore, obesity represents a risk factor for the development of benign and malign gastrointestinal (GI) conditions such as nonalcoholic fatty liver disease,[1] cholelithiasis,[2] severe acute pancreatitis,[3] complicated diverticular disease,[4] colorectal adenoma,[5] GI cancers[6] and gastroesophageal reflux disease (GERD).[7] Recently, a higher prevalence of several other functional upper digestive disorders has emerged. By means of a standard questionnaire based on Rome Criteria, Fysekidis et al. analyzed 120 consecutive patients who were candidates for bariatric surgery and reported that 89% of patients complained of functional symptoms; in particular, 31% esophageal and 38% gastroduodenal symptoms.[8] The frequency of functional GI disorders attributed to the gastroduodenal regions is higher than that for the distal regions, even if their overall prevalence has not been studied in detail. Owing to their chronic course, these disorders have a bearing on public spending and their correct diagnosis would avoid unnecessary cost-consuming investigations. The objective of this review was to analyze this topic in a unified manner, with an attempt to analyze the pathophysiological mechanisms involved, and to compare the presence of upper GI symptoms in obese patients before and after bariatric surgery in order to understand why and how surgery may change a patient's clinical assessment.

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